Pgo - 59: Tumors Of The Female Genital Tract

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ovarian cancer - up to what age are tumors more likely benign

Back 1

up to 45 years of age

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risk factors for ovarian cancer

Back 2

- nullparity
- genetic factors
- smoking cigarettes
- OCPs decrease risk

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genetic risk factors for development of ovarian tumors

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- mutations of BRCA1 and BRCA2 suppressor genes
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Turner syndrome (45,X)
- Peutz-Jeghers syndrome (hereditary intestinal polyposis syndrome)

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Lynch syndrome

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- hereditary nonpolyposis colorectal cancer

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classification of ovarian tumors

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1) surface-derived tumors
2) germ-cell tumors
3) sex cord-stromal tumors
4) metastasis

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features of surface-derived ovarian tumors

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- account for 65-70% of ovarian tumors
- derive from coelomic epithelium
- account for the greatest number of malignant ovarian tumors
- malignant tumors commony seed the omentum

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features of germ cell tumors

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- account for 15-20% of ovarian tumors
- cancers are similar to those seen in the testicle
- small numbers are malignant

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features of sex-cord stromal tumors

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- account for 3-5% of ovarian tumors
- derive from stromal cells
- may be hormone-producing
- majority of tumors are benign

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metastasis account for ----% of ovarian tumors

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5%

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common primary cancers metastasizing to ovaries

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breast, stomach (Krukenberg)

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ovarian cancer
1) % benign
2) % malignant
3) % of all cancers in women
4) % deaths

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1) 80% are benign – young (20-45)
2) 20% are malignant - older (>40)
3) 6% of all cancers in women.
4) 50% deaths due to late detection.

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surface epithelial tumors - types

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- Serous: resemble tubar epithelium
- Mucinous: mimic the moucousa of cervix or gut
- Endometrioid:endometrial epithelium
- Clear cell: resemble endometrial gland in pregnancy
- Transitional: resemble the mucosa of the bladder
- Mixed

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serous tumors

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Frequently bilateral (30-66%).
75% benign/bord., 25% malignant.
One or few cysts, papillary/solid.
Tall columnar ciliated epithelium.
Papillary, solid, hemorrhage, necrosis or adhesions – malignancy.
Extension to peritoneum – bad prog.(20-30%)
Loss of supressor gene p 53

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mucinous tumors

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Less common 25%, very large.
Rarely malignant - 15%.
Multiloculated, many small cysts.
Rarely bilateral – 5-20%.
Tall columnar, apical mucin.
Pseudomyxoma peritonei.
Prognosis: 5 years survival 60%

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endometrioid carcinoma

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Develops from endometriosis
30-50% bilateral
5 years 50%

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brenner's tumor (transitional cell tumor)

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- Rare (2% of ovarian tumors) , smooth, solid, fibroepithelial tumors
- Usually asymptomatic
- Thought to result from metaplasia of coelomic epithelium to uroepithelium
- Appear smooth, firm, grey-white (similar to fibroma)
- Masses or nests of epithelial cells surrounded by fibrous stroma
- coffee-bean nuclei - Reinke´s crystaloids

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Granulosa cell tumor- adult type

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Yellow, luteinized granulosa cells
Diffususe, insular, trabecular
Call-Exner bodies
75% estrogens
Survival: 5 years 90%
Complications

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Call-Exner bodies are found in

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Granulosa cell tumor- adult type

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appearance of Call-Exner bodies

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rosettes of cells with nuclei radially arranged

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thecoma

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Postmenopausal
Benign
Contain steroidogenic cells
Produce estrogens or androgens
Collagenous stroma and lipid-laden stroma cells
Complications

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fibroma

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75% of stomal tumors
All ages, mainly premenopausal
Benign
Resemble stroma of normal ovarian cortex
Meigs sy: fibroma, pleural effusions, ascites

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sertoli-leydig cell tumor

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(arrhenoblastoma/androblastoma)
Potentially malignant
weak androgens (dehydroepiandrosteron)

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Steroid Cell Tumor

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Cells resemble lutein cells, Leydig cells
Androgenic manifestation, masculinizing signs 75%
Reinke crystaloids (rodlike)

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germinal tumor - nondifferentiated =

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dysgerminoma (ovarian seminoma)

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germinal tumor - differentiated
1. directly
2. extraembryonic tissue
3. embryonic tissue

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1. embryonal carcinoma
2. endodermal sinus (yolk sac) tumor & choriocarcinoma
3. teratoma (ectoderm, mesoderm, endoderm)

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cell of dysgerminoma

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clear, glycogen-filled cytoplasm and central nuclei

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teratoma

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Germ cell tu, differentiates toward somatic structures
At least 2 layers
25% of all ovarian tumors – dermoid cyst
Struma ovarii
Mature
immature

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yolk sac tumor

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Necrosis, hemarrhage
Various growings patterns
Schiller-Duval bodies
Prognosis: 80%

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Schiller-Duval bodies are found in

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yolk sac carcinoma of ovary

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choriocarcinoma

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Rare
Cytotrophoblast, syncytiotrophoblast
Before puberty cause pubertas praecox
HCG
In adults more commonly connected with pregnancy

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Secondary ovarian cancer/metastatic

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- 3% of malignant ovarian tumors
- Primary: mamma, colon, endometrial , stomach
- If infiltration grossly invisible – primary most often mammary gland
- If infiltration grossly obvious – primary most often colon cancer
- Krukenberg tumor – ovarian metastasis with patches of signet ring cells, in 75% primary source stomach

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differentiated VIN

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In older females
Not connected with HPV
Originates often from dystrophic changes
Rarely independent, commonly in the proximity of carcinomas
Ungraded

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Microinvasive squamous cell carcinoma

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Invasion through the basement membrane
Invasion less than 1 mm
Horizontally less than 5 mm
Fibrotization of the adjacent stroma

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Squamous cell carcinoma of the vulva - incidence

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80-90% of vulvar lesions

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Squamous cell carcinoma of the vulva - 2 pathogenetic types

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1) Originating from classical VIN: Younger females, connected with HPV
2) Originating from differentiated VIN (originating from inflammatory vulvar disease): Older females, not connected with HPV

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vaginal tumors

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Squamous cell ca (VAIN I-III)
Clear cell carcinoma: Precursor vaginal adenosis
Exposure DES in utero
Prognosis: 5y 40-50%
Sarcoma botrioides: polypoid grape like mass
Melanoma
leiomyosarcoma